布-加综合征肝脏病理学与肝静脉和下腔静脉阻塞类型的相关性研究

Study on the relationship between pathological features of liver and obstruction types of hepatic vein and inferior vena cava in Budd-Chiari syndrome

目的:探讨布-加综合征肝脏病理学改变与肝静脉、下腔静脉病变的关系。方法:27例布-加综合征患者术前行彩超检查,术中常规行下腔静脉造影和选择性肝静脉造影或经皮肝穿刺肝静脉造影了解肝静脉、下腔静脉阻塞情况;影像引导下经皮肝穿刺组织活检了解肝脏病理学变化。根据病变累及血管分为肝静脉型、下腔静脉型、肝静脉和下腔静脉混合型;根据血管阻塞程度将其分为狭窄型和完全闭塞型。将肝脏病理学改变与肝静脉、下腔静脉阻塞情况进行相关性分析。结果:25例穿刺组织达满意组织学诊断要求,其中肝静脉阻塞型11例,下腔静脉阻塞型4例,肝静脉和下腔静脉混合阻塞型10例;狭窄型7例,完全闭塞型18例。肝纤维化程度与血管阻塞程度密切相关;肝血窦扩张和肝细胞变性与血管阻塞程度无关,肝脏病变与阻塞部位无相关性。结论:肝静脉和下腔静脉阻塞对肝脏的损害程度是一致的,血管阻塞程度较阻塞部位对肝脏损害的影响更大。

Objective To study the relationship between pathological features of liver and obstruction types of hepatic vein and inferior vena cava. Methods The preoperative color Doppler ultrasonography, intraoperative the inferior vena cava angiography and selective hepatic vein angiography or percutaneous transhepatic hepatic vein angiography were performed in 27 cases to learn the circumstances of hepatic vein and inferior vena cava obstruction. The percutaneous hepatic biopsies were performed in the guidance of images to learn the pathologic changes of liver. The cases were divided into three types （hepatic vein type, inferior vena cava type, hepatic vein combined inferior vena cava type） according the vessels involved or were divided into two types （narrow type, occlusive type） according the serious degrees of vessel obstruction. The relationships between them were analyzed. Results Twenty-five specimens were satisfactory. Eleven cases were hepatic vein type, 4 cases were inferior vena cava type and 10 cases were hepatic vein combined inferior vena cava type. Seven cases were narrow type and 18 cases were occlusive type. The degree of liver fibrosis was related with the degree of vessel obstruction, but the degree of hepatic sinusoid dilation and hepatic cell degeneration was not related with the degree of vessel obstruction. The pathological features of liver had no correlation with the position of obstruction. Conclusion The lesion of hepatic vein is consistent with the lesion of inferior vena cava to the injury of liver. The degree of obstruction is more important than the position of obstruction in judging the injury of liver.